Evaluating the Progression to Hypothyroidism in Preconception Euthyroid Thyroid Peroxidase Antibody-Positive Women.

Autor:	Gill S; College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK., Cheed V; Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK., Morton VAH; Birmingham Women's Hospital Academic Department, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TG, UK., Gill D; College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK., Boelaert K; Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT., Chan S; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.; Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore 117609, Singapore., Coomarasamy A; Birmingham Women's Hospital Academic Department, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TG, UK., Dhillon-Smith RK; Birmingham Women's Hospital Academic Department, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TG, UK.
Jazyk:	angličtina
Zdroj:	The Journal of clinical endocrinology and metabolism [J Clin Endocrinol Metab] 2022 Dec 17; Vol. 108 (1), pp. 124-134.
DOI:	10.1210/clinem/dgac525
Abstrakt:	Context: Thyroid peroxidase antibody (TPOAb) positivity is prevalent in women of reproductive age and predisposes to thyroid dysfunction, particularly hypothyroidism, which has adverse effects on pregnancy. Objective: This study aimed to report the rate of development of abnormal thyroid function among initially euthyroid TPOAb-positive women recruited into the TABLET trial, to identify factors associated with the development of hypothyroidism, and to compare outcomes between euthyroid and treated hypothyroid individuals. Methods: This observational cohort study, conducted at 49 UK hospitals between 2011 and 2016, included euthyroid TPOAb-positive women 16 to 40 years of age with a history of miscarriage or subfertility, planning pregnancy, randomized to levothyroxine 50 mcg daily or placebo. Abnormal thyroid function, conception rate, and live birth rate (LBR) ≥34 weeks were analyzed. Results: Among the women, 70/940 (7.4%) developed subclinical (SCH) or overt (OH) hypothyroidism: 27/470 taking levothyroxine and 43/470 placebo (relative risk [RR] 0.63; 95% CI, 0.39-1.00; P = 0.05); 83% of cases emerged prepregnancy. Baseline median serum TSH concentrations and TPOAb titers were significantly higher in those who developed hypothyroidism vs those who did not (P < 0.001). Treated SCH/OH demonstrated a higher failure-to-conceive rate compared with euthyroid women (adjusted RR 2.02 [1.56-2.62]; P < 0.001). The LBR ≥ 34 weeks was similar in the treated SCH/OH and euthyroid groups (adjusted RR 1.09 [0.77-1.55]; P = 0.6). Conclusion: Approximately 7% of euthyroid TPOAb-positive women will develop hypothyroidism within 1 year preconception or in pregnancy. Conception rates are lower in women with treated SCH/OH compared with euthyroid women, but LBR are comparable. Thyroid function in TPOAb-positive women should be monitored regularly, when trying to conceive, to ensure prompt diagnosis and appropriate treatment initiation. (© The Author(s) 2022. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu